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Table of Contents
10 Things You Need to Know About Your Thyroid

Learn the basics about your thyroid plus the ten things you must know
in order to identity and correct an over or under-active thyroid condition.
Hypothyroid Testing
Hypothyroidism is an under-diagnosed condition. Find out how you can
identity symptoms and make changes to get well!
The Thyroid-Adrenal Connection

A connection between operating in chronic survival mode and the thyroid 
exists. Learn how to heal both of these conditions and reclaim your life.
 
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from AvivaRomm LLC or any subsidiary are intended to be used for education
purposes only. ThIS information is not intended to diagnose, treat, or cure any
disease, nor are the views expressed by Aviva Romm, MD intended to be a substitute
for conventional medical services. If you or a family member has a medical
problem, or if you suspect that you or a family member has a medical problem,
promptly contact your health care provider.
Thyroid Insights 1 Aviva Romm, MD. © 2015

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10 Things You Need to Know About Your Thyroid 
 
 
Most of us are no stranger to a little bit of fatigue now and then, a few
pounds we wouldn’t mind losing, the occasional irregular period, or blue mood.
But if you are struggling with any of these on a regular basis, with some
severity, or a cluster of these symptoms, your thyroid function may be the
culprit.
What is the Thyroid Gland?
Your thyroid gland is the thermostat regulating energy for your entire body. It
controls everything from your mood to your menstrual cycles to your
metabolism – and about a thousand other biological functions – including how
efficiently you burn calories and how easily you lose weight.
The thyroid gland is shaped like a butterfly and is located in the

front center of your neck, about midway between the under
part of your chin and that lovely dip at the base of your neck.
Through a series of chemical reactions, the thyroid gland takes iodine and
repurposes it into fuel for numerous important functions throughout your
entire body. This fuel starts out mostly in the form of the inactive hormone
Free T4 which is then supposed to be converted as needed into the active
form of the hormone called Free T3 – which does the heavy lifting!

Thyroid Problems Come in Several General Varieties
 
The most common forms of thyroid problems are: 
• Hypothyroidism, which is under-functioning of the thyroid gland (energy and

metabolism are low)
• Hyperthyroidism, which is over-functioning of the thyroid gland
(metabolism is running on overdrive!)
• And autoimmune forms of under- and overactive thyroid (Hashimoto’s
and Graves disease, respectively) or due to other causes ranging from
nutritional deficiencies to infection and inflammation (thyroiditis).
Hypothyroidism is the most prevalent form of thyroid disease, and thus is by

far the most commonly diagnosed thyroid condition. Hashimoto’s disease
accounts for 90% of all hypothyroidism in the US.
Fast Fact

The 10 Top Things You Need to Know About Your Thyroid
(#4 is a doozy!) 
 
1 | Having the right amount of thyroid hormone for your
individual needs is essential to your well-being.  
 
With an underactive thyroid, you might experience fatigue, constipation, dry
skin, brain fog or trouble concentrating, depression, anxiety, hair loss,
depression, joint and muscle aches (even carpal tunnel syndrome and
tendonitis!), generalized swelling, cold intolerance (or you always feel a little
cold) dry skin, even an excessively low heart rate.
If you have an overactive thyroid, you might experience a rapid heartbeat,

anxiety, insomnia, insatiable appetite, diarrhea, and weight loss. If you think
you have a thyroid problem, it’s okay to be a squeaky wheel to your doctor.
Squeaky wheels get the testing they need!
2 | Women are way more likely than men to develop thyroid
problems, and the months after birth are an especially
high risk time for thyroid problems to surface.  
 
If you feel unusually blue in the year after the birth of your baby, or at any
time, and especially if you have any of the above symptoms, get tested for
thyroid problems!

3 | Your high cholesterol could be caused by an
underactive thyroid.  
 
Say what? Yes, it’s true. Hypothyroidism can lead to high cholesterol because
slower metabolism isn’t burning up your fat. So before you go on special diet
or a statin drug to control your cholesterol – get your thyroid levels checked.
The answer might be in finding the root cause – a thyroid problem!
4 | Most doctors UNDER-DIAGNOSE thyroid problems.
Thyroid problems may affect as many as 10% of women – but for many of
these women, the labs tests that doctors currently use, and the way those
tests are interpreted, leads many women to be told that they don’t have a
thyroid problem, and in fact, they are just fine.  
 
THIS TRANSLATES AS: “This is all in your head because I, with my medical
degree, cannot find a darned thing wrong with you, Lady.” And this often
results in an antidepressant prescription. I check the following labs on my
patients in whom I, or they, suspect thyroid problems: 
 
TSH
Free T3
Free T4
Thyroid Peroxidase Antibodies
(TPOAb)
Thyroglobulin Antibodies (TgAb)
Reverse T3

5 | Hypothyroidism can be causing
your fertility problems and also
increases miscarriage risk.
Thyroid function controls fertility and menstrual

regularity. If you’ve been having trouble getting
pregnant, if you have irregular periods, think you
are not ovulating, or have had a miscarriage,
have your thyroid function checked BEFORE
you get pregnant to make sure your levels are
optimal.
6 | Optimal thyroid functioning is also essential for
the healthy development of your baby’s brain.
Pregnant women with hypothyroidism automatically need to have their thyroid

hormone medication increased by 50% in the first trimester to support the
increased metabolic needs of the baby. Make sure to talk with your midwife
(who might not know this!), or your primary care doctor or obstetrician who
might not remember to adjust your medication dose.
7 | Having a hard time losing weight?
Tuning up your thyroid gland will rev up your metabolism and burn calories
without you having to do anything extra. If you’ve tried diet after diet, exercise
program after exercise program without success, it might be time to tap into
the root causes – and hypothyroidism might just be one of them.

8 | Thyroid glands need nourishment!
Make sure your diet and your daily supplements provide you with iodine,
selenium, and zinc which are three key nutrients needed by the thyroid gland
for basic functioning. Sea vegetables such as 1 tablespoon of dulse flakes daily
provides you with a nice dose of iodine, just 1-2 Brazil nuts each day provide
you with ample selenium, and zinc is found in beef, oysters, dark meat chicken,
cashews, pumpkin seeds, almonds, yogurt, and many other sources.
9 | Fluoride, bromide, and chloride coming from your
diet, fluoridated water, toothpaste, or other
environmental exposures, can interfere with the
iodine your thyroid needs to function.
If you are having a hard time regulating your thyroid function, even with
medications and a supportive doc, look for sources of these in your life and
try to reduce/eliminate exposure.
10 | In gluten sensitive individuals, eating FOODS
containing gluteN (wheat, barley, rye) and possibly
even some of the gluten cross-reactive foods can
cause Hashimoto’s disease.
A 3-month trial of going strictly gluten-free might be

needed to see if your thyroid antibodies return to normal
and your thyroid begins to recover function.

You Can Get Well 
Thyroid problems can be fixed! I help women to achieve healthy thyroid function in my
practice every day. In most conventional medical practices, you may have to advocate
for yourself in the doctor’s office to get the testing you need.
A functional medicine, integrative medicine, or naturopathic doctor will usually

automatically be willing to test the whole gamut of thyroid tests for you. You have to be
careful not to get over-diagnosed and unnecessarily treated if you don’t actually have a
thyroid problem, however if the symptoms and the labs fit – then appropriate
treatment can make you feel like a million bucks!
 
Sometimes thyroid function can be

recovered and restored with natural
methods using stress reduction, diet,
herbs, and supplements. Sometimes
medications are needed long-term.
But either way, it is important to
identify whether you have a thyroid
problem so you can get the help you
need to feel like yourself again.

Hypothyroid Testing 
What You Need to Know & Ask For
Just recently a patient came into my practice feeling fatigued, moody, was having
heavy periods, no libido, and was bothered by constipation. She also wasn’t sleeping
well – waking up too early in the morning and unable to fall back to sleep, and she’d
gained 7 pounds in just a couple of months even though she hadn’t changed her eating
habits.
All are signs of hypothyroidism.
We talked. She really didn’t feel that stress was causing her symptoms – nothing in her
life was really that troublesome. She had no outlier symptoms that suggested another
diagnosis. She was pretty sure something was wrong with her thyroid so she’d asked
her primary doctor to check her thyroid labs before scheduling to come see me for an
more integrative medicine consult. He’d checked her thyroid stimulating hormone (TSH)
test only, and told her that since it was still in the normal range, even though it was at
the upper end of normal, she did not have a thyroid problem. He sent her on her way
suggesting that maybe an antidepressant would be good to consider.
But her labs weren’t normal. One step over a very thin line and she’d have had a slam
dunk diagnosis of the most common thyroid problem: hypothyroidism. And in fact, this is
what I diagnosed. She started appropriate treatment and her energy and symptoms
quickly began to improve!
This is a typical story.

Getting to The Bottom of Thyroid Testing
While not all hypothyroid-like symptoms turn out to be a problem with the thyroid or
thyroid hormones, we do know that statistically, hypothyroidism is an under-diagnosed
condition. In fact, only about half of Americans with a thyroid problem know they have
one, and it is estimated that this can be as many as 4-10% of Americans
Hypothyroidism is the most common thyroid problem, and Hashimoto’s disease, an

autoimmune form of hypothyroidism, is the most common form of all. Women are much
more likely than men to have thyroid problems. Hypothyroidism can appear at anytime
but is especially common after childbirth and is prevalent in woman in their 40s and
50s.
Yet so many doctors seem reluctant to do an adequate work-up of thyroid function.

Some even refuse! This seems strange given how common thyroid problems are, and
yet they are quite willing to freely prescribe antidepressants. My patient’s doctor was
doing just what we were all told to do in medical school – check the TSH and if that’s
within what we were told is the normal range, there’s no problem. But there’s much
more complexity to thyroid testing than that! Sadly, so many women are left believing
that their symptoms of depression, fatigue, joint aches, weakness, weight gain and
more are all in their head! Perhaps this has even happened to you.
In reality, your symptoms could be due to hypothyroidism.

What is the Thyroid?
The thyroid is a butterfly-shaped gland that sits at front of your

neck and sets your entire metabolic rate. Thus it controls your
weight, whether you feel sluggish or energetic, mentally crisp or
foggy, cheerful or blue, and is involved in the control of everything
from your cholesterol to your female hormones.
When your thyroid is not functioning optimally, you can feel dull, tired, constipated, gain
weight, your skin gets dry, your hair can become dry and even fall out, muscles and
joints might ache, your periods become irregular, you might have fertility problems,
brain fog, sugar and carb cravings (because your body is desperate for energy!), high
cholesterol even if your diet is amazing, and other large to small symptoms.
What is Hypothyroidism?
Hypothyroidism is a term used to describe a decreased metabolic state that is due to

inadequate amounts of – or functioning of – thyroid hormone. Ninety-five percent of all
cases are due to what is called “primary hypothyroidism.” This means that the thyroid
gland is acting sluggish – or sometimes barely responding at all. This can be due to a
number of reasons ranging from leaky gut to autoimmune disease.
Alternatively, we can be producing thyroid hormones effectively, but we can have

“thyroid hormone resistance” similar to the way we can have insulin resistance. Our cells
are not picking up and effectively using the active thyroid hormone we are making. We
can also be making enough of the inactive form of thyroid hormone but not be
effectively converting it to the active form.

While hypothyroidism can also be due to more serious problems in the hypothalamus
and pituitary, this is rare. However, chronic or substantial stress can suppress the
pituitary gland enough to interfere with thyroid hormone production.
Symptoms of hypothyroidism include: 
• Fatigue
• Increased sensitivity to cold
• Constipation
• Dry skin
• Unexplained weight gain
• Cravings for sugar and carbohydrates
• Puffy face
• Muscle weakness
• Elevated blood cholesterol level
• Muscle aches, tenderness and stiffness
• Pain, stiffness or swelling in your joints
• Heavier than normal or irregular menstrual periods
• Thinning hair
• Slowed heart rate
• Depression
• Impaired memory (“Brain fog”)
Because these symptoms are so common to so many women, hypothyroidism is often

dismissed as “just normal symptoms” or depression! One patient of mine was accused
of overeating by her primary doctor as the cause of her weight problem when she
actually had a thyroid problem!

The 6 Key Thyroid Tests
There are 6 key tests that can unlock the mystery of your thyroid function and are what
your doctor should be looking at. Thyroid testing should be simple to obtain from your
primary doctor or local lab.
However, the nuances may take some skill to interpret, depending on the results, and
your doctor might be resistant to ordering more than the TSH test. That’s where an
open-minded endocrinologist or a skilled Functional Medicine doctor can be of help!
In my practice, if my patient’s
symptoms are highly suggestive
of hypothyroidism, I will run the
entire thyroid panel described
below right up front. If there are
other diagnoses that are equally
likely, I will run just the first 3
tests (Panel 1), and if these
come back borderline or positive
for thyroid or thyroid hormone
problems, I will then add in the
remainder of the test panel
(Panel 2). I will also sometimes
recheck test results for TSH,
FT3, and FT4, if normal in a
newly symptomatic patient, in
6-12 weeks, because I’ve occasionally seen initial testing be normal then a short time
later, voila – the tests come back confirming the problem.

Thyroid Stimulating Hormone (TSH)
Thyroid Stimulating Hormone (TSH) is produced in a part of your brain called the
pituitary gland. The job of TSH is to tell the thyroid gland that it’s time to get busy
producing more thyroid hormone. When the healthy thyroid gets this chemical message,
it produces two hormones: triiodothyronine (T3) and thyroxine (T4),
The normal range for TSH is somewhat controversial. Most labs consider the upper
range to be between 4 and 5 mU/L. However, many experts – even in conventional
endocrinology – believe that the upper end of normal is actually more like 2.5-3 mU/L.
This is based on the fact that when Americans without any hypothyroid symptoms have
this test done, that is the most usual upper range.
Many integrative and functional medicine doctors find that their patients feel their best
at an upper limit of 1.5-2 mU/L.
My patient was one of these people. At a TSH of 4 she was really at the upper limit of
normal, over the preferred upper limit according to some docs, and well over the 1-2
mU/L upper range! This controversy and discrepancy of opinion over the normal upper
range for TSH is one of the most common reasons that women get under-diagnosed
for hypothyroidism and suffer with unnecessary symptoms that can seriously interfere
with health and quality of life.
In most cases hypothyroidism occurs because the thyroid gland is sluggish – that is, it is
having trouble producing T3 and T4. This can be due to a variety of reasons ranging
from nutritional deficiencies to autoimmunity. So TSH gets pumped out in a higher
amount to try harder to stimulate the thyroid gland into action. Think of it like this: You
are TSH. Your best friend’s house is the thyroid gland. When you go to visit your friend
you knock on her front door. If she doesn’t answer, what do you do? You knock louder to
get a response. In just the same way, the TSH amps up to knock louder, hoping to get

an answer. That’s why an under-functioning thyroid shows up as high TSH on lab tests.
However, TSH can be normal in the presence of hypothyroidism in some cases, and you
can still be having the symptoms of low thyroid when TSH is normal because of poor
conversion of T4 to T3 (see below) or because of thyroid hormone resistance at the
level of your cells.
When stress is suppressing the pituitary gland enough to interfere with producing TSH,
you might see low or normal TSH levels in the presence of low thyroid hormone
production (T3 or T4), and hypothyroid symptoms.
Thyroid Hormones (T3 and T4)
Triiodothyronine (T3) and thyroxine (T4) are the hormones produced by your thyroid
gland. T4 is produced in a much larger amount and is then converted to T3, the active
form of the hormone, as needed to up-regulate metabolic functions. T3 and T4 are
sent out into your bloodstream where they are responsible for the thyroid’s actual work
of controlling your metabolism. Free T3 (FT3) and Free T4 (FT4) are called this
because they are not bound to proteins in your blood, making them free to perform
their work in your cells – keeping your metabolism appropriately revved up for your
optimal health.
Measuring FT3 and FT4 is important because they are the indicators of thyroxine and
triiodothyronine activities in the body. A high TSH and low FT4 and FT3 indicate
hypothyroidism. A normal TSH, normal FT4, and low FT3 can indicate T4 to T3
conversion problems, and a normal or high TSH, normal FT4 and high FT3 can indicate
cellular resistance to FT3 which can still lead to hypothyroid symptoms because the
active hormone can’t get to the cell to do its job.

Thyroid Antibodies
Thyroid antibody testing is ordered to diagnose
autoimmune thyroid disease and distinguish it from
other forms of thyroid dysfunction.
The two thyroid antibody tests that I order are Thyroid peroxidase antibody (TPOAb)
and Thyroglobulin antibody (TgAb). Some people do have an autoimmune thyroid
condition but don’t initially test positive.
If positive, antibody testing can be repeated every six months to trend improvement
while you are working with an integrative physician to address possible underlying
causes.

Reverse T3 (rT3)
Reverse T3 is the third most abundant form of thyroid hormone. When your body
wants to conserve – rather than “burn” – energy, it will divert the active T3 into an
inactive “reserve” form. This might happen when you are sick, under stress, or
undernourished. If TSH and FT4 look ok, but FT3 is low this can be because it is being
diverted into rT3 – which will be elevated. It is worth checking rT3 if there are obvious
symptoms suggesting hypothyroidism, but the typical tests aren’t demonstrating low
TSH or low FT4.
There is some controversy amongst conventional doctors about the utility of this test –
I personally find it very useful.

Additional Testing
If labs return showing that there is hypothyroidism, then I also test for deficiencies of
selenium, iron, and zinc and make sure there is adequate dietary intake or
supplementation if needed, and look for environmental factors that can interfere with
iodine utilization, for example, fluoride and bromide exposures from water and flame-
retardant products, respectively. I will then also start to look more closely for other
underlying causes, for example, gluten intolerance, heavy metal exposure, and other
environmental triggers.
Talking with Your Doctor About Thyroid Testing 

(or Switching Doctors)
As a doctor, I can tell you that in medical school we are taught that doctors know best.
But this is often not the case. You are your body’s best expert. After all, you live with
you all the time! And you have a right to ask for basic testing and receive it. We’re not
talking about tens of thousands of dollars in MRI’s and CT scans here – we’re talking
about modest amounts of blood work.
That said, do discuss your symptoms with your doctor because there’s a lot of hype in
the natural medicine and natural products world, and your doctor is possibly just trying
to protect your from the opposite problem – getting OVER-diagnosed or misdiagnosed
with a thyroid problem – and believe me, I’ve also had many patients who were put on
thyroid medications by integrative practitioners when these meds were not needed.

If you are unable, however, to have an honest conversation with your doctor, if you feel
your doctor is not listening or is condescending, then that’s another issue. You should be
able to have mutually respectful conversations with your care provider, to get the
answers you are seeking, and to be able to explore your concerns.
If you can’t, then figure out whether the obstacle is in your being unable to speak up
because of a perceived power differential (many of us become weak in the knees when
we face our doctors, especially if we feel vulnerable about our health) or whether your
doctor is just not communicating respectfully. And make the change!

Heal Your Thyroid by Getting Out of Adrenal Survival Mode
It’s dark and it’s late. You’re coming out of a club in the city heading back to your car,
which is parked on a poorly lit side street. About 50 yards from your car door, you
notice a man crossing the street toward you. Nobody is on the street.
Your heart is racing, and your muscles tighten. You are on red alert. Should you run?
Prepare to fight? Your keys are already in your hand – you could use them to defend
yourself. Your fingers clench so tightly around the keys that you feel them digging
into your palm. You recognize this feeling. It’s terror.
Now closer to you, you hear the man’s footsteps stop and from the corner of your
eye you catch light coming from an open apartment building door. You hear laughter.
You turn your head slightly and see a woman step out of the building. She embraces
that man. More laughter…
Your shoulders drop, your breathing relaxes after a huge exhale accompanied by a
nervous and relieved chuckle. You release the grip on those keys clenched in your
hand. You’re safe.
Threat, Perceived Threat, and The HPA Axis

 
This man never was an actual threat to you. But your nervous system’s fight or flight
response, the primitive survival mechanisms that start in your brain and quickly extend
into your entire hormonal system through the hypothalamic-pituitary-adrenal axis
(simply say HPA axis and you’ll still sound wicked smart!) didn’t know this. Your brain is
so exquisitely tuned to protecting you that it just responds to your perception of danger
and there you go – fasten your seat belt because you’re going on a stress-hormone ride!

This HPA axis is incredibly effective at mobilizing the energy you do need to run – or
fight. Sugar is pumped into your bloodstream in rapid fire. Your body even breaks down
fat and muscle to create extra sugar in case it’s needed. Insulin is pumped out to
regulate the sugar. Your blood vessels constrict, causing your blood pressure to go up.
Your body directs energy away from any functions that aren’t needed in the face of
danger – like digestion and reproduction, affecting your gut and your hormone balance.
When the danger is done, your body is designed to quickly recover without any lasting
damage. The extra blood sugar gets swept up into your cells by the insulin, your blood
vessels relax, and blood flow returns to your gut and reproductive hormones once again
get released in normal amounts. All of the numerous changes caused by the activation
of the HPA axis return to normal.
Thankfully, most of us do not find ourselves on dark roads thinking we’re being followed
too often. However, most of us do experience more minor levels of stress on a day-to-
day basis that keep us in survival mode. And if we’ve had past trauma of any
magnitude, even relatively small, we are more primed to perceive situations as
threatening.
Chronic Survival Mode
Here are just a handful of situations that keep us in chronic survival mode. I’m
sure you can probably relate to one or more: 
• A periodically or chronically stressful work environment/boss/co-workers

• A stressful home situation or relationship
• Financial stress
• Illness in yourself or a family member

• Episodes of low blood sugar because you’ve been too busy to eat much more
than a cup of coffee and a muffin, or you’ve skipped meals all together
• Poor sleep making you feel irritable, crave sugar, and feel at the end of your rope
• Being overwhelmed by things to do, and feeling like you’re never going to get
them done
• Getting stuck in traffic on your way to a meeting or to pick your kids up at school
• Running late and getting stressed out about it
• Having to get your taxes in and your bills paid
These are all real stressors that activate the HPA axis – and are even more activating if
you’ve been fired from a job, experienced a relationship trauma as a child or adult,
been exposed to vulnerability due to severe financial stress, or any other stressful past
trauma, or perceived potential disaster.
Your perception of each incident as a possible threatening trigger is even higher.
When chronically activated, the HPA axis puts us in a state of on-going survival mode,
and this can have a huge impact on numerous aspects of our health, leading to:
• Overweight, especially around the middle, and difficult-to-near impossible weight

loss
• Difficultly falling asleep, poor sleep, or waking up tired after a full night of sleep
• Poor immunity, getting sick a lot
• Chronic exhaustion, overwhelm, poor emotional, mental or physical resilience
• Irritability, anxiety, feeling tired and wired, depression, hopelessness
• Sugar, caffeine, and other food cravings
• Episodes of low blood sugar
• Insulin resistance, metabolic syndrome, high blood pressure, high cholesterol
• Poor mental function, concentration, or memory problems

• Hormonal problems from irregular periods to fibroids to infertility to PCOS to
hypothyroid
I want to emphasize the connection between being stuck in survival mode, and its effect
on thyroid function, and offer you tools to heal both.
The Adrenal-Thyroid Connection
Your thyroid gland, the butterfly shaped small organ at the front of your neck, performs
literally hundreds, if not thousands, of essential functions related to growth, metabolism,
hormonal control, and utilizing and conserving energy depending on what your body
needs moment to moment. Your adrenal glands, two tiny triangular glands (I mean you
blinked you missed them small!) sitting atop your kidneys, control the hormones and
nervous system chemicals that regulate your stress response, immunity, blood
pressure, your reproductive hormones, and much more.
When you are under prolonged chronic stress your adrenal system tells your body to
conserve, rather than spend too much energy. Your thyroid slows down, too. It’s like a
warning system that protects you from over-drafting on your energy bank account.
Further, chronic adrenal stress has a major impact on your immunity – over time
increasing your risk of developing chronic inflammation and autoimmunity.

These are the two primary gateways that lead from the chronic overdrive of your
survival mechanisms – your adrenal function – leading to Hashimoto’s thyroiditis, or
autoimmune hypothyroidism which is responsible for about 90% of all thyroid
dysfunction in the US.
When you are under stress, immune system chemicals called inflammatory cytokines
(which have names like IL-1 beta, IL-6 and TNF-alpha) are released. These “down
regulate” (medical speak for decrease) the production of the key thyroid related
hormones TSH, T3, and T4, make the thyroid less sensitive to TSH which stimulates the
function of thyroid hormone production, and decreases the conversion of the inactive
form of the thyroid hormone T4 to the active form, Free T 3. Acute stress can do this
for days; chronic stress can make this a more regular state and in time, lead to thyroid
suppression – or hypothyroidism. Chronic inflammation also makes the thyroid hormone
receptors on your cells less sensitive to the active form of thyroid hormone, such that
thyroid hormone can’t do its job. This is called thyroid hormone resistance.
Remember how I also said that chronic stress diverts energy away from important
functions like your gut and your reproductive hormones? These can also have an
impact on your thyroid function.
When you are under stress, blood flow gets directed
away from the lining of your gut, and also, the
chemical environment of stress has a direct impact on
your gut flora leading to overgrowth of the more
harmful species at the expense of the good guys.
Both of these gut changes can lead to a condition called leaky gut which makes you
more susceptible to all manner of food triggers and harmful gut bug triggers from
gluten to dairy to numerous other foods, and to developing a condition called
“endotoxemia,” all of which in turn can lead to inflammation in your body significant

enough to ultimately lead to autoimmune conditions. Cutting out food triggers as part
of reducing the stress your body is under is an important part of healing the adrenal-
thyroid connection. An elimination diet and 4R program can help you to identify food
triggers, heal your gut lining, and improve your gut flora.
Hashimoto’s thyroiditis is the most common autoimmune disease in the US, affecting far
more women than men, and rates are on the increase along with our stress levels! It’s
also a vicious cycle, because the more our body perceives stress due to inflammation,
the more the stress response system gets triggered. We pump out more cortisol, one
of our key stress and inflammation protection hormones, which in turn causes us to gain
more weight, break down muscle for fuel, and store extra fuel as harmful forms of
cholesterol.
Cortisol reduces our ability to clear estrogen from our system through our liver.
Increased estrogen up regulates (medical speak for increases) the production of a
carrier protein called thyroid binding globulin (TBG) which does exactly what it sounds
like – binds onto thyroid hormone. Bound forms of thyroid hormone are not very active
– so your thyroid function goes down even when your thyroid is pumping out the stuff
like it’s supposed to. The active free form just doesn’t get to your cells where it’s
supposed to do its good work.
The problem gets even more complex, because it’s part of the role of the thyroid to
metabolize cholesterol – so not only is your overworked or now exhausted adrenal
stress system causing you to produce more cholesterol, inefficient thyroid functioning is
preventing you from using it up. BOING: you end up with high cholesterol even if your
diet seems pristine!
Not to mention, you’ve either got the symptoms of hypothyroidism: fatigue, weight gain,
dry skin, constipation, thinning hair, irregular hormone function and menstrual or
gynecologic problems, and more, or you’ve actually developed Hashimoto’s!

 
The Adrenal-Thyroid Cure
You can nip these vicious cycles of the stress-adrenal-thyroid connection in the bud –
or kick them in the butt! Here’s what you’ve gotta’ do:
1 | Become familiar with your signs of stress response, or
being stuck in survival mode.
Once you learn to recognize them, you can learn to respond quickly with a relaxation
response, rather than react with a prolonged stress response. See # 3 below for
relaxation response techniques.

2 | Identify those areas of your life that need attention so
that you can get out of survival mode and into a life that
you love living.
This might mean saying no to some things you’ve taken on, rethinking how you approach
your work:life ratio, take more time for self care so you can have the resilience to cope
with what’s on your plate, rethink your economics to want less of what you don’t really
need and earn more so you can have what you do need, reaching out to friends
(oxytocin, the love hormone gets released when we connect with peeps we love, and
this is a counterbalancing hormone to the stress system).
3 | Develop a regular stress decompression practice.
We all need tools for on the spot stress reduction, and also regular self-care habits that
keep our nervous system well fueled for meeting life’s inevitable stresses. My favorite
exercise for traffic jams, the sudden urge to quit your job or throw something at your
boss is called “the quickie.” Here’s how to do it: Center yourself wherever you are, sitting
or standing or lying down, feeling the parts of your body touching the ground…just feel
that grounding with the earth. Breathe naturally at first, then after a few breaths, inhale
for 4 counts while saying I am in your mind. Then exhale for 4 counts while saying at
peace to yourself. Repeat this I am…at peace cycle at least 4 times.
4 | Keep your blood sugar balanced.
You’re feeling shaky, in a hot or cold sweat, and

losing your concentration. Maybe you’re a little
nauseated or even faint. You realize you haven’t
eating since this morning and it’s already mid-
afternoon. Ok you’ve eaten at little bit, but just

coffee and a Danish – not real food! Most of us gals know the feeling – we’ve been
there at one time or another. The blood sugar crash, or “food emergency,” is super
common – and it takes a major toll on the adrenal stress system. You see, your brain is
DEPENDENT on a steady supply of sugar to keep it happily humming. Low blood sugar
is a brain emergency of the highest magnitude.
So you’ve got to’ feed your head. Regularly. With protein, good quality fats, and carbs
from whole grains and veggies. My top tips for keeping your blood sugar steady are: eat
protein at breakfast, don’t skip meals, graze on high protein snacks if your blood sugar
tends to tank, and keep a healthy emergency food stash within reach.
5 | Use adaptogens to support your
adrenal stress response and cool
down your immune-inflammatory
reactions.
Adaptogens are a special class of herbal medicines

that have been used in Traditional Chinese and
Ayurvedic medicines for centuries to promote a
sense of well being. In those systems, these herbs
are considered the “Kings” and “Queens” of herbal
medicines for restoring health, vitality, immunity,
stamina, and promoting longevity. The term
adaptogen refers to the unique ability of these
herbs to help you adapt to the stress in your life.
They do this by “normalizing” or “regulating” the
adrenal stress response.
Adaptogens help your body to cope more effectively with the demands of everyday
life. They provide a sustained sense of calm, and while they increase energy, with the

exception of Chinese ginseng, they are non-stimulating. In addition to their effects on
stress adaptation, adaptogens have profound antioxidant and anti-inflammatory
effects that protect your cells from damage from a variety of chemical exposures.
Also, one of the definitions of adaptogens is that they are non-toxic, even with long-
term use. You can rely on these herbs to be safe and gentle.
My “Top Five” adaptogens are:
Tupac, Nas, Lauren Hill…I mean, Holy Basil, Ashwagandha, Rhodiola, American Ginseng,
and Reishi.
Taking care of your stress system will help quiet down your inflammatory responses,
allowing your thyroid to more effectively produce thyroid hormones and revert
Hashimoto’s antibodies (I’ve seen this happen many times!), and allow your cells to
convert and use those thyroid hormones.
In the process, you’ll find yourself more energetic, resting better, losing those love
handles you just don’t love and couldn’t get a handle on, your cravings will fade, and life
will seem so much easier!

About Dr. Aviva Romm
Aviva Romm, MD is The Women’s Natural Doctor.

She has bridged her interests in traditional medicine
with her knowledge of hard science for over 3
decades. A midwife and herbalist for 25 years, as
well as a Yale trained MD, Board Certified in Family
Medicine with Obstetrics, she completed the
Integrative Medicine Residency through the
University of Arizona, and practiced Functional
Medicine for 2 years at The UltraWellness Center
with Dr. Mark Hyman.
Dr. Romm's focus is on women’s and children’s health, with an emphasis on the impact
of stress on health, energy, food cravings, weight, chronic disease, and hormone
imbalance. She is also an avid environmental health advocate, focusing on the impact of
toxins on fertility, pregnancy, women’s hormones, chronic illness and children’s health.
Dr. Romm is one nation’s leaders in the field of botanical medicine and is the author of 7
books on natural medicine for women and children, including the textbook Botanical
Medicine for Women’s Health. She is also the integrative medicine curriculum author for
the Yale Internal Medicine and Pediatric Residencies.
Recently named by Mind Body Green as one of the 100 Women to Watch in Wellness,
Dr. Romm lives and practices medicine in Massachusetts and is a nationally sought
speaker, author, and consultant.

Connect With Dr. Romm to Learn More
www.avivaromm.com facebook.com/AvivaRommMD twitter.com/AvivaRomm

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Table of Contents

10 Things You Need to Know About Your Thyroid

The Thyroid-Adrenal Connection

for conventional medical services. If you or a family member has a medical

promptly contact your health care provider.

Thyroid Insights 1 Aviva Romm, MD. © 2015

What is the Thyroid Gland?

The thyroid gland is shaped like a butterfly and is located in the

Thyroid Insights 2 Aviva Romm, MD. © 2015

• Hypothyroidism, which is under-functioning of the thyroid gland (energy and

Hypothyroidism is the most prevalent form of thyroid disease, and thus is by

Thyroid Insights 3 Aviva Romm, MD. © 2015

1 | Having the right amount of thyroid hormone for your

individual needs is essential to your well-being.

If you have an overactive thyroid, you might experience a rapid heartbeat,

2 | Women are way more likely than men to develop thyroid

problems, and the months after birth are an especially

high risk time for thyroid problems to surface.

Thyroid Insights 4 Aviva Romm, MD. © 2015

4 | Most doctors UNDER-DIAGNOSE thyroid problems.

Thyroid Insights 5 Aviva Romm, MD. © 2015

your fertility problems and also

increases miscarriage risk.

Thyroid function controls fertility and menstrual

6 | Optimal thyroid functioning is also essential for

the healthy development of your baby’s brain.

Pregnant women with hypothyroidism automatically need to have their thyroid

7 | Having a hard time losing weight?

Thyroid Insights 6 Aviva Romm, MD. © 2015

9 | Fluoride, bromide, and chloride coming from your

diet, fluoridated water, toothpaste, or other

environmental exposures, can interfere with the

iodine your thyroid needs to function.

10 | In gluten sensitive individuals, eating FOODS

containing gluteN (wheat, barley, rye) and possibly

even some of the gluten cross-reactive foods can

cause Hashimoto’s disease.

A 3-month trial of going strictly gluten-free might be

Thyroid Insights 7 Aviva Romm, MD. © 2015

A functional medicine, integrative medicine, or naturopathic doctor will usually

Sometimes thyroid function can be

Thyroid Insights 8 Aviva Romm, MD. © 2015

All are signs of hypothyroidism.

This is a typical story.

Thyroid Insights 10 Aviva Romm, MD. © 2015

Hypothyroidism is the most common thyroid problem, and Hashimoto’s disease, an

Yet so many doctors seem reluctant to do an adequate work-up of thyroid function.

In reality, your symptoms could be due to hypothyroidism.

Thyroid Insights 11 Aviva Romm, MD. © 2015

The thyroid is a butterfly-shaped gland that sits at front of your

Hypothyroidism is a term used to describe a decreased metabolic state that is due to

Alternatively, we can be producing thyroid hormones effectively, but we can have

Thyroid Insights 12 Aviva Romm, MD. © 2015

Symptoms of hypothyroidism include:

Because these symptoms are so common to so many women, hypothyroidism is often

Thyroid Insights 13 Aviva Romm, MD. © 2015

Thyroid Insights 14 Aviva Romm, MD. © 2015

Thyroid Insights 15 Aviva Romm, MD. © 2015

Thyroid Hormones (T3 and T4)

Thyroid Insights 16 Aviva Romm, MD. © 2015

Thyroid antibody testing is ordered to diagnose

autoimmune thyroid disease and distinguish it from

other forms of thyroid dysfunction.

Thyroid Insights 17 Aviva Romm, MD. © 2015

individual needs is essential to your well-being.  

high risk time for thyroid problems to surface.  

Symptoms of hypothyroidism include: 

Talking with Your Doctor About Thyroid Testing 